8/31/07

157) Home Dialysis?

August 30, 2007
Thursday

El Milagro: As I rush in and weigh myself I’m a little cognizant of a display in the corner and two women standing there talking… and hear something about peritoneal, so I assume it’s another peritoneal sales job going on out there. Later I find out from Rosie the Tech that it’s a ‘show and tell’ about home dialysis… the way El Milagro can make more money by having folks do the dialysis themselves at home and not even utilize the resources of the center.

Anyway, I shoot past there and settle into a corner chair (not ‘my’ corner), saying “Hi” to John on the way. Rosie comes over to poke me and we talk about home dialysis (HD) and she reports about her best friend who is on HD and how it takes more time to set up and take down than he wants to use, so she ends up helping him out with it. She warns that it isn’t all its cracked up to be since there is about an hour of set up/take down, 3 hours on the machine, and you do it every day.

Rosie finishes with me and then Phyllis the Nurse comes up to listen to my heart and she starts in… “Jack; HD is something I’d think you’d be excited about…” saying you get better clearances and can take less binders. She says Bear loves it and he takes less binders as a result. I counter that I’m lazy and it seems like a lot of work… and I conclude that I like coming here and being served by the staff cause they are so nice and competent. She laughs at that and shakes her head at my honesty. So, I guess I need to think more seriously about HD as an option.


Just off the top of my head, I lean away from using HD. But then, a few minutes later, one of the HD minions hired by the establishment to sell the system to all us chair-tied people comes up to talk to my neighbor about HD. Michael the HD guy says, “When I get off I feel the same as when I started. I don’t get that wiped out feeling. Also, while dialyzing I can stand up and move around some. Sticking yourself is the hardest part. They ship supplies to your house.” And various other things in response to my neighbor’s questions.

My own thoughts that are leaning away from the idea of HD include 1) having Shayna see me dialyzing every night; 2) dragging the machine on my 4 to 5 out-of-town trips every month; 3) having to deal with this dialysis stuff EVERY day instead of three times a week; 4) having to learn and be responsible for my own treatment… and I’m sure there are others. All these notions are in the face of Phyllis’ statement that HD is better for me… so, maybe I need to really consider that too. So it goes.

Notes: In at 74.8 and out at 72.2 kgs.
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8/30/07

156) Arroz con pollo

Aug 25, 2007
Saturday

El Milagro:
I’m in at 10:30 this morning, after Phyllis the Nurse called last night to reserve an early chair for me. I drove over here from Martha’s garage sale, where I picked up a couple books, a table runner, and a martini shaker. As I am getting stuck by Jason the TV is on the food channel, which I seldom watch because it always makes me hungry and I’m usually jealous of the cooking skills of the people I see on their shows. However, before I can escape the food channel, I get hooked by arroz con pollo!* Jason, meanwhile is asking me if each poke is okay and if there is any pain (which can indicate that one of the needles is up against the side of the vein) and I am trying to talk to him while I’m watching a soundless food show. I recall simultaneously that last Thursday when he was sticking me, we discussed his growing up in Buda and attending Hayes High School. Turns out he knows my old boss, Mitch and even went on trips to the Frio River along with Mitch and family. It is a small world indeed.

Today I only watch TV: food shows, mythbusters, and some other Discovery Channel nature show. It is all a blur and I can only concentrate on zooming home at the end to try out this recipe, thinking it’ll be a great addition to our chile feast coming up.

Notes: In at 75.8 and out at 72.3 kgs.
*
Simply Delicioso with Ingrid Hoffmann Paint party retrieved online from http://www.foodnetwork.com/food/show_ih/episode/0,,FOOD_29816_52361,00.html
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8/19/07

155) Two Dialyses in a Row

Aug 18, 2007
Saturday

El Milagro: I’m in early again today at 11:30 after dialyzing just last night after the conference. It’s really weird coming in on a Friday afternoon / evening (due to conference activities Thursday afternoon/evening) and then again on Saturday morning. I actually weighed in at 73.5 Kg., less than I left last night at (73.6).

On the way in I touch base with New John who recommends a novel by a Texas hill country author and we talk for a few minutes about our reading habits… and Rosie the Tech about getting the notes from the last PAC meeting… and Monica the Nurse about lab work Moritz wants to add to the next lab draw next Tuesday.

So, here I am and Matt sticks me and we talk about his going to college at TSU down in San Marcos. I tell him my daughter is just starting there and we swap college stories during my cannulation. I haven’t seen Matt since he started working mornings. James the Nurse comes up and checks my heart, etc., and I haven’t seen him in ages either.

I tune in to Folkways on KUT and read the Venkatesh book [check this one out, Hans] about the interesting ways people make it using the “underground” economy in south-side Chicago. While I’m reading, Tom Pittman is playing some really great music this morning, including Lucinda Williams, Lyle Lovett, John Prine & Mac Wiseman (see pic), Laura Love (Saskatchewan --> an incredible song), and Elana James.

Debbie the Tech comes over to say “Hi” and mentions that In & Out Burger (my t-shirt today) is her favorite place to eat in Las Vegas. I reply that I’ve never been to one… hear they're good… and got the shirt for the racing 426 Sport Fury on the back… gift from Johnny’s visit to LA this summer.

Later: Doing dialysis two days in a row wiped me out. I went to a birthday party after dialysis and had to leave after only an hour or so cause I was feeling tired, brain dead, and a little dizzy. Came home, crashed out and slept for hours. So it goes.

Notes: In at 73.5 and out at 71.7 kgs., BP 117/65
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8/15/07

154) Conference Dialysis

Aug 14, 2007
Tuesday

El Milagro: I’m in my favorite corner today, having rushed over here early from the TNOYS Conference down the road (Pre Conf Institute with Barry Duncan*), and then waited until 4:15 to get poked. So it goes. As Eloy is cannulating me Dr. Rowder rolls up with his chart cart and Monica the Nurse hanging behind. In response to his “How’s it going?” I report going to see Moritz yesterday for my annual doctor’s visit and that we have a new script… Rowder nods and says something like, “Good. I was going to have to schedule you so I’m glad you took care of that.” So, both he and I are happy about my assertiveness. That’s good.

I settle into a long nap and then read a little of de Shazer’s last book; More than miracles: The state of the art of SFBT. I’m thinking this is going to be one of my texts if my solution-focused therapy class gets accepted at the school. Before I know it Carol is there to unhook me and patch me up. My BP is pretty low tonight… probably cause they took off over 7.5 pounds. I am driving home dizzy, Gillespie.

Notes: In at 75.8 and out at 72.3 kgs.
*See Institute for Study of Therapeutic Change online at www.talkingcure.com/
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153) Dr. Visit with Moritz

Aug 13, 2007
Monday

Central Texas Kidney Associates: Walking into the doctors’ offices I am aware that I haven’t been here in ages. There’s a new receptionist, although I hear Connie the Nurse in her office talking to someone on the phone. I sign in and pay my co-pay and have a seat. Pretty soon Rick the Med Tech comes out and says “Hi… long time, huh?” or something similar indicating relationship over time and some pleasure at reconnecting. He takes me down the hall to a lime green treatment room that reminds me of offices in Mexico or the Carribean.

Rick does all the normal checkup things like review my meds, take my BP, and the less formal things like asking me if I noticed how he has changed since we last met. He reports he has lost some weight and looks good (although he always looked good to me). We talk a bit about my experiences with dialysis and he informs me he has read this blog. [Hi Rick!] Rick leaves and I wait for Dr. Moritz…

I stare around this treatment room… lime green with natural wood beam and plank ceiling… and one good-sized brightly colored framed painting-print of one of those post impressionist scenes of a patio or tropical something where the only thing that makes an impression is the large blotches of hue with lines around them that indicate it actually is a scene. A few posters of kidneys and kidney parts that I imagine the doc pointing to with one of those telescoping pointers as he is educating someone. And of course, the little kidney models that almost look like little colorful sculptures on legs… I remember his showing me how my kidney was abnormal on one of these things ten years ago now…

Finally Moritz makes an entrance, wearing his customary Hawaiian shirt, khakis, and health shoes. In response to his salutation I say, “I have some feedback and a few questions for you”. He sits and exhibits expectant silence by cocking his head ever so slightly… and, I continue to recount my dismay and displeasure at hearing from the dialysis center staff that I was reassigned to another doctor (ref. May 2007, Post # 130) without asking my permission or giving me notice. And, evidently, without any consideration of the relationship I’d built with Moritz over 10 years! I recount that even though some people might think of him as obnoxious or tactless, I happen to be okay with those qualities in him and I believe we have had a good doctor/patient relationship over the years. And, I am NOT interested in being transferred to another doctor! Moritz listens to me quietly, waiting for me to completely finish my tirade. So, I continue, “I don’t mind Rowder signing my scripts but I am not going to consider him to be my nephrologist. On my insurance and in my mind you’re my doctor.” He replied with the following statements (maybe not in the particular order I report them here).
• “I was on vacation when they made those changes
• He has 25 years more experience than Rowder (in response to my interjection that I don’t think Rowder is as smart as Moritz)
• Dr Rowder is an employee of “the group” (indicating the partners in CTKA)
• With “groups” a necessary difficulty is that the group overtakes any individual doctor’s intentions and that all the doctors, individually, if asked, would say they know that group procedures are not best practice.
• The whole TTS 3rd shift was switched to Rowder because they needed to find something for him to do when they hired him and the group wants one doc per shift at the center.
• It has been the procedure in the group to write a letter to folks to explain changes like this, but they just didn’t get around to it this time
• Moritz is now handling MWF 1st and 2nd shift only.

By now he and I are talking into the last half of an hour and I tried to summarize our discussion and left it at telling him that I think I have to write a letter to “the group” explaining my complaint and recommending they make some changes in how they do their business.

So, on with the doctor’s visit. Moritz addresses my medical questions (explaining some things and looking up some things on his laptop) and concerns, changes a prescription, adds a prescription. Now I’ve been in there almost an hour and as I’m leaving I’m thinking that was good use of my $30 co-pay. I wonder if they assigned me the usual 15 minutes or if they never assign anyone for a 15 minute with Moritz, cause I know he always goes way over with most people who can get past his ‘directness’.

I am satisfied with our conversation even though Moritz didn’t give me any indication that he could/would change me back to him. However, on their computers he is my doctor, but when he printed out a script for me, it came out with Rowder’s name on it and that causes him some bewilderment. And, as I said to him, from my view, he continues to be my doctor.

Notes: In at 164 lbs, 5’11 1/2“
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8/12/07

152) Of Golf & the Urban Poor

Aug 11, 2007
Saturday

El Milagro:
I am here at 1 pm after Herman the Nurse called me at noon, saying they have a chair if I want it. I almost always want the early chair. I get stuck by Carol the Tech as Phyllis the Nurse and I discuss college years and college credits. She too graduated with 160 hours in her undergraduate degree from Kansas State.

Not much to report today. I am reading my new book: Off the books: The underground economy of the urban poor by Sudhir Venkatesh. This is gonna be a really interesting book about how people live under the radar. Generally many of us think of the down and out segment of the society with some pity and maybe even a little disdain. They may remind us of how our country marginalizes portions of the society, and maybe they even remind some of us of how we could slide into their state. And yet these folks have their own culture and their own way of eking out a living in their communities that Venkatesh has integrated into, observed, and reported compassionately in this book. I’m delving into the book whiletrying to follow the golf at the same time. Interesting combination, huh?

It’s the 89th PGA Championship on the TV. Tiger is paired with Scott Verplank, evenly at the beginning, but then Scott falls off and I think about how much pressure one must feel playing alongside Tiger and trying to keep up. Plus, they’re playing in the 100+ temperatures of Oklahoma today.

This place is pretty much like normal today. One of the normalities is the recurrent beeps calling techs to adjust people’s machines. The machine of the woman beside me beeps every 5 or 6 minutes and someone has to go adjust it, but they don’t flip her needles or anything, so I wonder what that’s all about. Usually when someone’s machine beeps a lot the tech will eventually come over and spend some time trying to either adjust the machine or adjust the needles so that the beeping stops. Sometimes the needles rest against the side of the arterial vein and this slows the flow and the machine doesn't like that so it beeps. Then the tech comes over and untapes the person, turns the needle over or adjusts it in the vein, and retapes the person. This time, with this woman, they just come over and hit the button that stops the beeping.... again.... and again... and again... until I almost say, "What's the deal Camille?" But I mind my own business and just wonder about the whole scene.

So it goes on this Saturday here at El Milagro, in Austin, on the planet. Tiger just bogeyed. So it goes in Oklahoma tambien.

Notes: In at 74.1 and out at 72.1 Kgs.
1) Of note, I am planning a trip to Washington in September to advocate for passage of the Kidney Care Quality & Education Act of 2007 Read more at the NRAA website: http://www.nraa.org/Bill_Sponsors.php

2) And, Liz and I have founded The Austin Folkies team to participate in the annual PKD Walk. Check us out by clicking the top Link on the black sidebar!
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8/8/07

151) Good Phosphorous Report

Aug 7, 2007
Tuesday

El Milagro:
I came in and am sitting in my favorite corner chair. Eloy comes over to stick me and is telling me about his sinus infection from allergies… maybe from the ragweed they’re saying is 10 ft. tall this year and a month and a half early. He sticks me and has to return later and turn over one of the needles cause it’s causing the machine to beep. Jennifer the Dietician calls over cheerily and then comes over to show me a new blood work report: my phosphorous is back to normal! Jennifer thinks that last ‘bad’ report was an anomaly, or a mistake, or the result of a faulty lab tech.

8-02-07 --> 5.0
7-10-07 --> 6.8 [ Normal is between 3.5 to 5.5 ]
6-12-07 --> 5.0


I settle back to read the Consumer Reports issue reviewing digital cameras, since I slipped into the Guadalupe River with Katie’s. I learn that I might be able to find a SLR body that I can use my old SLR lenses with. That would be great since I have some great lenses for my old Minolta. That’s the good news. The bad news is the price of all these cameras is way more than I want to pay. I’ll probably just go out and try to get Katie’s Kodak Easy Share fixed… or buy a new cheapo one like it.

Jennifer the D returns with a tray of plastic cups of Bow-Tie Pasta Salad. She looks and sounds like a Vana or one of those sample girls you find at the grocery store, hawking the newest product in a can. She tries out her spiel on me first, pitching the pasta while conceding that the concoction could use some spices… either Mrs. Dash or Tabasco sauce. I enthusiastically taste the pasta and it’s alright to me and I tell her so. I mostly think it is a grand idea to go around the place giving away healthy food samples for folks to taste cause I hallucinate that half the people here don’t really try to eat a dialysis diet because they don’t really want to try new things (Maybe that’s just me… although at my house we are eating a kidney-friendly diet for years now). I also like the idea of Jennifer walking about holding a tray of food samples, smiling, and giving them to people… just because it has the look of a stewardess service in the place. Service with a smile, and all that. Giving good things to eat to people and all that.

I watch Drew Cary’s new show and watch the very first contestant (a 19 year old college kid) win a million bucks to use for med school, and that is a fun thing. Also, I like the idea of polling people about their views and then having folks guess what percent of the population thinks thus and so. I like guessing those kinds of things myself, so it is interesting to see it on TV. And so it goes here in dialy-land.

Notes: In at 75.1 and out at 73.6 Kgs.
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8/6/07

150) Undocumented Workers Antithesis of Steelhead Trout

Aug 4, 2007
Saturday

El Milagro:
I was invited to come in at 1 today, which was great, since Liz and I just told 6 people to bring 15 of their relations to dinner tonight and Liz will hafta do the prep work cause I’m getting my blood cleaned. I will get home just in time to crank up the NBBD grill and barbecue chicken, steelhead trout*, and shrimp kabobs.

Herman cannulated me and we discussed friends visiting from out of town and using maids now (to make our places hospitable) and in the past in El Paso / Fabens. Also we agreed about how all these folks who are screaming about stopping the ‘illegal aliens’ because ‘they take our jobs’ don’t get how this part of the population is necessary for the dominant culture’s comfort, as well as not understanding the argument about the jobs in question. After all, how many of the ‘unemployed’ people listed at the Employment Commission would rush out to clean hotel rooms, work the fields, wash dishes, or do bone-wrecking manual labor for the kinds of wages the ‘illegals’ work for. In just the farm-worker arena, a 1996 article predicted the “…prices of fresh fruits and vegetables (would raise) by about 6 percent in the short run…” if we shut the valve on undocumented workers.** Do we want higher prices as a trade for corking the border? Do we want to discontinue centuries of a foundation work force that props up the American Dream? We as a society have always scorned this part of the labor force, but we historically understood how they fit in and we turned our heads as they worked their way up the ladder from menial to semi-skilled to skilled labor and built their own communities and melded into the American Way. We in the dominant culture paid them a miserable wage because we could (they had to accept anything thrown their way). With the cinching up of the border belt, these folks (the illegals and their employers) will slip further into the underground economy*** to survive. And survive they will… as they have since the beginning of this great country.

The neo-conservative faction of the government and their cronies would have you believe that this isn’t the case as they work to restore “integrity to our immigration system and secure America’s borders”****. Actually this is all a sleight of hand move: misdirecting us from the substantial issues of national security in the post 9/11 era; like randomly checking all those huge shipping crates being floated into our harbors or the convoluted way of tracking people already identified as dangerous. No… they’d rather you pay attention to the poor undocumented workers looking for an honest day’s work in the land of promise. The sleight of hand moves actually drive folks who simply want a break to illegal and nefarious dealings. Meanwhile, many of the neo-con’s supporters who own large agri-business corporations, the hotel industry, and the garment industries will continue to use undocumented workers in ever more disparaging ways that will simply be more obscured. And the more surface level use of ‘illegals’ will fade away and those jobs will finally go to people who will work half as hard, do a mediocre job, and get paid three times as much money. It makes me mad!

I say, let ‘em all in to chase the American Dream; give ‘em all “green cards”, but change the color to peach. Peach has a less demeaning connotation, emphasizes a new beginning, and sounds cool: “I got my peach card” he said. “Well, that’s just peachy!” Let’s see, in Spanish that would be, “Consegu√≠ mi tarjeta del melocot√≥n”. Now that really doesn’t sound bad, does it? (Looking for a comment from my Mexican friends here --> agree? disagree?)

I mean…” (said like Arlo, dragging out that ‘eeeeen’)… “I meeeeeeeeen… when the border patrol stops those boys out on a desert road somewhere in the Socorro…. ….they pulls ‘em up and says… ‘Now straighten up boy! We gotcha and now we’re gonna give ya a ride into town, a hot meal, and yer very own Peach Card. ….Whaddaya say to that Mijito? Welcome to the Promised Land. Now hop on in and let’s skidaddle.” Wouldn’t that be grand?

Oh yeah. And this idea about charging a fee to these folks to enter our country and take jobs no one wants anyway is just ridiculous. If we want to charge someone, let’s charge foreigners with Master’s Degrees coming in. They can get their Fortune 100 Companies to spot ‘em the bucks for that. And let’s use that money to improve our miserable inner city schools that youth are leaving in response to inadequate and antiquated policies and curriula. I could go on and on, cause I seem to be on a tirade now. Calmase Juaquin! Whew.

Okay, so once hooked up, I listened to Folkways and then Live Set with the Austin Lounge Lizards and then turn on the news. The woman next to me has bad cramping somewhere during this time and they take her off early and talk to her about massaging and moving her legs. I wanted Herman to go over and actually help her by holding her feet, but he was busy in another sector. He can’t be everywhere at once.

Well, that’s about it from the brain of Jack. And so it goes.

Notes: In at 73.4 and out at 72.7 Kgs.
* Rainbow Trout retrieved August 2007 from Wikipedia, http://en.wikipedia.org/wiki/Rainbow_trout
** Huffman, W. * McCunn, A. How much Is that tomato in the window? Retail produce prices without illegal farmworkers. Retrieved August 2007 from The Center for Immigration Studies website:
http://www.cis.org/articles/1996/back296.htm
*** Venkatesh, Sudhir Alladi (2006) Off the books: The underground economy of the urban poor. Cambridge, MA:, Havard University Press. Retrieved online July 2007 from
http://www.hup.harvard.edu/catalog/VENOFF.html
**** Border security and immigration reform. Retrieved online from the website of John Cornyn, US Senator,
http://cornyn.senate.gov/public/

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